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Glue ear

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Long-term glue ear can affect a child's hearing and speech development

Glue ear is one of the most common childhood illnesses, and occurs when the middle ear becomes filled with sticky fluid. It’s usually temporary and often linked with ear infections, but long-term glue ear can affect children's hearing and speech development.

What is glue ear?

Glue ear happens when the middle ear (behind the eardrum) becomes filled with sticky fluid. Otitis media with effusion (OME) is the medical name for glue ear. It’s very common – 1 in 5 pre-school children have glue ear at any one time and 8 out of 10 children will experience glue ear before the age of 10.

For ears to work properly the middle ear needs to be kept full of air. The air travels through the eustachian tube which runs from the middle ear to the back of the throat. In children this tube is not as vertical and wide as it will be when they get older and as a result doesn’t work as well. If the eustachian tube becomes blocked, air cannot enter the middle ear. When this happens, the cells lining the middle ear begin to produce fluid. This is a runny liquid which can get thicker as it fills the middle ear. If your child has glue ear your GP may describe their ear or ears as being ‘congested’.

With fluid blocking the middle ear, it becomes harder for sound to pass through to the inner ear, making quieter sounds difficult to hear.

Parents, Scott and Siobhan, talk to us about what it's like for their son, Bayley, to have a cleft palate, his glue ear operation and hearing loss in our video.

Spot the signs of glue ear

These signs can often be mistaken for stubbornness, rudeness and being naughty. You could ask your child’s teacher, or other people your child has had recent close contact with, if they’ve noticed any of these signs.

Glue ear (otitis media with effusion) can cause temporary deafness and a prolonged period of time with reduced hearing can affect children’s speech and language development, for example, parts of words may not be pronounced clearly. They may also fall behind at school if they don’t have extra support.

What should I do if I think my child has glue ear?

Arrange an appointment with your GP. Often glue ear is associated with a heavy cold and will clear up when the congestion from the cold has gone.

Your GP will examine your child’s ears and should be able to tell if they have glue ear. They may describe your child’s ear or ears as ‘congested’. If there is any pain or sign of infection your GP may prescribe a course of antibiotics. It’s likely that your child won’t receive any treatment for the first three months, but they should be monitored by your GP, known as ‘watchful waiting’. If the symptoms continue your GP, health visitor or school nurse can refer you to the audiology or ear, nose and throat (ENT) department at your local hospital.

How do they test for glue ear?

An audiologist will examine your child’s ears and a further assessment will be carried out. This will include a tympanometry test, which measures how well the eardrum can move. If there is fluid in the middle ear the eardrum won’t move properly.

A graph (called a tympanogram) will show the results straight away. A hearing test should also be done to check if the glue ear is affecting your child’s hearing and by how much. These tests are very quick and are completely painless.

The audiologist should explain the results of all the tests and discuss the best way to manage your child’s symptoms. It’s a good idea to monitor the glue ear with repeated tests at least three months apart. For most children, the glue ear will clear up in this time. If it hasn’t, you may be offered grommets or temporary hearing aids.

Breastfeeding

It’s known that breast milk provides essential nutrients to help children to fight off infections in the first few months of their life. Breastfeeding also passes on the mother’s natural protection against illness. Research has shown that children who have been breastfed from birth are less likely to get glue ear at a young age. Ask your GP or health visitor for more information.

It may help to feed your baby (either breastfeeding or with a bottle) in a sitting position rather than lying flat. This helps prevent fluids entering the eustachian tube during feeding.

Smoke-free environment

Research carried out by the Department of Health has shown that all children are more likely to get ear infections and glue ear if they’re often in a smoky environment. A child is likely to experience glue ear for as long as the environment remains smoky.

Parents should try to make their children’s environment smoke-free e.g. the home and car. If it’s not possible to make the environment entirely smoke-free, then smoking should be confined to an area not used much by children. It’s important to remember that simply opening a window is not enough, as many dangerous smoke particles will stay in the air.

Allergies

Research suggests that allergy may be related to persistent glue ear in some children. You can ask your GP about testing your child for allergies or referral to an NHS allergy clinic if you think this might be the cause. Allergies to fur, pollen, dust mites or some foods may cause the eustachian tube to swell and this can prevent fluid from draining from the middle ear. For more information on allergy, you may like to contact the charity Allergy UK.

Most cases of glue ear will clear up by themselves, but a temporary hearing loss as a result of a prolonged episode of glue ear can affect a child’s speech and language development and you may also notice a change in their behaviour.

You should take your child to see your GP who will examine your child’s ears and see if they have glue ear. Your GP may monitor your child to see if the glue ear resolves by itself. If it doesn’t, your GP will refer your child to the audiology or ear, nose and throat (ENT) department at your local hospital for a hearing test. If your child is diagnosed with glue ear and their hearing is affected, the audiology or ENT department at the hospital will monitor the glue ear over a period of three months. This is known as ‘watchful waiting’. At the end of this period, your child’s hearing will be retested to see if the glue ear has resolved. If there’s no improvement, surgical intervention, such as grommets, or hearing aids may be offered.

Grommets

Grommets are tiny plastic tubes that are put in the eardrum. They allow air to circulate in the middle ear and help to reduce the fluid from further building up. This is usually done as a day case and is a short operation in hospital under general anaesthetic. The grommets are inserted after the fluid in the middle ear has been drained away.

A discharge (occasionally blood-stained) may occur for a couple of days immediately after the operation. After this time there shouldn’t be any discharge. If there is, you should see your GP for advice and antibiotic drops. Any prolonged discharge from the ear should be assessed by your ear, nose and throat (ENT) doctor.

Grommets usually stay in for around 6–12 months until the eardrum has healed and pushed them out. Sometimes the fluid comes back and another grommet operation may be considered.

Our comic for children under 10, Harvey Gets Grommets, explains why Harvey gets grommets, what happens when he visits the doctor, and what happens at the hospital when the grommets are put in. [link to resource]

Swimming and bathing with grommets

Your ENT doctor will recommend keeping your child’s ears dry for the first 2–4 weeks immediately following the surgery. After this, most children with grommets don't need to take any special precautions and can swim and bath as usual with grommets in. There are a few children who may be at a particular risk of infection due to water entering the ear. If your child is one of these, your ENT doctor may suggest some of the following precautions.

Try to avoid your child diving or jumping into the water as this increases the outside pressure and forces water through the grommet into the middle ear.

Avoid your child swimming in lakes or non-chlorinated pools. The water in these places usually has a high bacteria count and infection is more likely to occur.

Be careful when washing your child’s hair. Soapy water is able to slip more easily through the grommet into the middle ear. If the water is dirty it will infect it. With your child sitting upright in the bath, wash their hair first before body washing. Tilt their head back and rinse with clean water, then apply a shower cap. This way your child can play in the bath without getting dirty, soapy water in their ears.

Otovent nasal balloon

The Otovent nasal balloon (also known as nasal balloon autoinflation) is a non-surgical, drug-free treatment option for glue ear. Autoinflation is a method of encouraging the eustachian tube to open. This can help drain the ear naturally through the eustachian tube, by forcing air from the back of the throat to the middle ear.

The Otovent is suitable for children from three years old. It consists of a balloon and a nosepiece. This treatment involves fitting the balloon to the nosepiece, putting the nosepiece against one nostril and keeping the other nostril and mouth closed. By blowing through the nostril, the balloon is inflated until it’s about the size of a grapefruit. The nosepiece is removed and the procedure repeated with the other nostril.

The Otovent may be helpful for some older children during the watchful waiting period or while waiting for grommet surgery.

Otovents are available on prescription. Ask your GP or ENT consultant about whether they think it will be suitable for your child.

Hearing aids

Hearing aids are devices designed to make sounds louder. They are used on a temporary basis for glue ear while waiting either for the glue ear to resolve or for grommet surgery. For children who have repeated problems with glue ear or are unable to have grommet surgery, hearing aids can be very helpful.

Good quality, digital hearing aids are available free of charge for all children on the NHS. Your child may also be offered a bone conduction hearing implant.

In 2008, the National Institute for Health and Clinical Excellence (NICE) published guidance about treatments for glue ear for the NHS in England and Wales. NICE currently recommends grommets or hearing aids as effective treatments.

For some treatments, there may be very little or poor quality evidence available. Some may also be offered by the alternative or complementary health sector, which doesn't tend to produce the type of scientific evidence reviewed by NICE.

They found the following treatments to be ineffective or lacked sufficient evidence to be formally considered effective.

Diet

It’s believed that your child’s diet can affect the amount of mucus their body produces. Dairy products (made from cow’s milk) and a high amount of sugar in a child's diet can increase the amount of mucus the body makes. A build-up of mucus may be a cause of glue ear. It’s important that a child has a balanced diet. If you think it may help to reduce the amount of cow’s milk in your child’s diet but you’re worried about your child lacking calcium, consider alternatives, such as broccoli, which are naturally high in calcium and calcium-enriched dairy alternative products. Always ask your GP for advice before changing your child’s diet.

Eating more healthy food with plenty of fresh fruit and vegetables, grains and lean meat or fish may help. You can also ask to see a registered dietician.

Homeopathy

Homeopathy is a type of care used to treat a wide range of conditions, including glue ear. It may help to stimulate the body’s own immune system by using tiny doses of natural substances. It’s often used to complement other forms of healthcare.

For more information, contact the British Homeopathic Association at:CAN Mezzanine49-51 East RoadLondonN1 6AH

All doctors who are listed practitioners with the British Homeopathic Association are registered with the General Medical Council and have undertaken training in homeopathy at a faculty-accredited postgraduate teaching centre.

Osteopathy

Osteopathy is a system of diagnosing and treating conditions, concentrating on the body's structure. This treatment can help to realign muscle tissue, bones and joints, allowing the body to function effectively and in doing so, may relieve pain and ailments.

For information about osteopathy and to find a registered osteopath who specialises in treating children in your area, contact the General Osteopathic Council. The General Osteopathic Council registers qualified osteopaths and sets standards of osteopathic practice and conduct. Their aims are to protect patients, to develop the osteopathic profession and promote an understanding of osteopathic care.

Phone: 020 7357 6655 (voice)The line is open between 9am and 5pm, Monday to FridayWebsite: www.osteopathy.org.uk

The Osteopathic Centre for Children (OCC) is a registered charity that offers osteopathic treatment to children up to the age of 18 for a wide range of conditions. The OCC has clinics in London. For more information contact: The Osteopathic Centre for Children (London)22a Point PleasantLondonSW18 1GGPhone: 0208 875 5290 (voice)The line is open between 9am and 5.45pm, Monday to FridayEmail: enquiries@fpo.org.ukWebsite: www.occ.uk.com

Xylitol

Xylitol is a plant-based product, which is usually used as a sweetener in food. It’s lower in calories than sugar and can be used by diabetics. Xylitol has been shown to inhibit the type of bacteria that can be a cause of tooth decay and ear infections.

Clinical trials have shown that xylitol-based chewing gum, when used regularly, may reduce ear infections and glue ear.

In the UK, xylitol can be found in small amounts in some types of chewing gum, children's vitamins and toothpaste. Other xylitol products currently available in the United States include granules, nasal sprays and sweets. A nasal spray containing xylitol has been developed and is available from health food and vitamins and supplements suppliers and online.

Support at school for children with glue ear

Children’s hearing can be affected for long periods of time while waiting to see if the glue ear clears up naturally or while on the waiting list to have the grommet operation or hearing aids. Some children will have glue ear for long periods that may persist through secondary school, so it’s important that your child’s speech and education doesn’t suffer.If the glue ear persists and leads to children experiencing mild hearing loss, research shows that it can have a major impact on their development, but fortunately, there are lots of things that schools can do to support children with mild hearing loss.

As a starting point, talk to your child’s teacher or the person who has been designated by the school to identify children with special or additional educational needs to ask for extra support at school. In England, this person is known as a Special Educational Needs Coordinator (SENCO). You could also talk to a Teacher of the Deaf (ToD) from the local authority specialist education service for deaf children.

The school aren’t taking my child’s glue ear seriously

Many parents of children with glue ear have told us that their child’s school doesn’t understand the impact glue ear can have on their child’s academic and speech and language development. They don’t always do enough to support children with glue ear.

children with medical conditions are supported so that they have full access to education, including to physical education and school trips

staff receive appropriate training

there is someone in charge of how the school supports children with medical conditions

they have a policy that sets out how they will support children with medical conditions (this should be readily available).

If you’re concerned about the support that your child is receiving, make sure that the school is clear that your child has a medical condition. Ask them how they’ll make sure they are meeting the requirements of the government guidance.

Wales

Scotland

If you live in Scotland, your child may be regarded as having ‘additional support needs’. Schools in Scotland are required to provide support for these children, even if this support is only needed for a short while. The Enquire website has more information on additional support for learning and on your rights in this area.

If your child’s glue ear is lasting for a long time and impacting on their education, they may be regarded as having special or additional educational needs. Schools and other education providers should provide special or additional educational support. Find out more about getting additional support at school.

If your child’s glue ear is likely to, or has, lasted for at least 12 months, without clearing up, then your child may be regarded as having a disability under the Equality Act. This means that schools and other education providers in England, Scotland and Wales must ensure they take steps to prevent discrimination and also proactively provide support to counter any disadvantage that your child may experience. Find out more about the Equality Act and your child’s education.

Northern Ireland

Northern Ireland has its own anti-discrimination legislation:

The Special Educational Needs and Disability (Northern Ireland) Order 2005 (SENDO)

The Disability Discrimination (Northern Ireland) Order 2006.

To find out more information on disability legislation in Northern Ireland call the Equality Commission for Northern Ireland on 028 90 890 890 or visit their website.

What you can do

Explain to your child’s teacher and/or SENCO that although glue ear is usually temporary, your child is deaf and needs extra help. Show them your child’s most recent audiogram so the school understands what your child can and can’t hear.

Seek advice from the local authority specialist education service for deaf children, who employ teams of Teachers of the Deaf (ToDs). Not all services provide direct support to children with temporary or mild hearing loss but they should provide the school with guidance and information. If your child has a hearing aid, they should have a ToD.

Share our resources with your child’s teacher (and anyone else who works closely with your child) to help them understand how glue ear or mild hearing loss affects children in the classroom and what steps they can do to help make listening and learning easier.

Encourage your child’s teacher to share our deaf awareness tips and resources with the other children so that they know how to communicate with, and include, your child.

Generally children with glue ear (otitis media with effusion) don’t experience problems flying, although sometimes doctors don’t recommend it depending on the current condition of the ears.

The build-up of fluid in the middle ear can expand during take-off and, more commonly, landing due to changes in cabin pressure, causing discomfort. The risk is the fluid expands so much the eardrum perforates; if this happens a doctor should prescribe antibiotics but there is normally no long-term damage.

Before flying, we strongly recommend seeing your GP who may prescribe decongestant medication.

Eating and drinking during take-off and landing will help open your child’s eustachian tubes and prevent discomfort. Special ear plugs known as ‘EarPlanes’ (available from pharmacies) can help to reduce discomfort from changes in air pressure.

My daughter and glue ear

Parents Peter and Rachel discuss the treatment options for glue ear they chose for their daughter, Libby, and how we helped them make the right decisions for their family.